If MPs are talking of being discriminated on their house allowances, then I guess they haven’t paused to consider the glaring discrimination in health. This is one area they made policies, like many, that favoured them more than those they represent in Parliament.
In my short interactions with hospitals, I have come to discover that most of those who benefit from NHIF are the ruling class and civil servants.
If you are self-employed, NHIF does very little for you on a Sh500 cover.
If the three-tier health scheme is not discrimination, then I fail to see what is. The Health Act 2017 offers many rights on paper but, realistically, it is all hogwash as the poor still struggle to access quality healthcare.
Take, for instance, a case of a maid we helped to deliver at home recently. She was taken into hospital after the excruciating birth only to be told she needed to pay for her care — because she delivered at home and, hence, did not qualify for free maternity care!
Labour pangs are indeterminate and can happen anywhere, anytime and in any place. Again, most poor, illiterate mothers are unaware of what is required of them to access healthcare. Why punish them for being ignorant?
One wonders what all the hullabaloo around free maternity care for mothers and babies is all about if it does not come with compassion.
There are many other fancy campaigns the Ministry of Health seems to engage with — from launching scanners to universal health coverage (UHC) itself — but I doubt if there are efforts on the ground to find out if these have any positive impact on ordinary Kenyans.
I am talking about assessments done honestly, transparently and free of political spin.
When the government talks of UHC, it should have equality at the centre of it. Having the ruling class on super private health insurance and suggesting priority NHIF cover for civil servants and the employed is not a way to create equality in healthcare.
What it does is lead to discrimination in provision of healthcare.
Setting the NHIF cover for the self-employed lower than that of employed civil servants automatically inhibits their chances of getting the care they deserve. The policy also assumes that all the self-employed are poor and cannot afford the premium cover.
The definition of self-employed in relation to NHIF needs to be reviewed to make healthcare accessibility fair. If ‘Mama Mboga’, jua kali artisan or millionaire businessman wish to pay a higher NHIF premium for themselves and their families, they should have the same opportunities as civil servants to do so.
The government has a legal duty of care to help the unemployed and the poor, and that should be clearly spelt out to citizens to speed up UHC.
NHIF patients on lower cover are between a rock and a hard place when it comes to accessing healthcare. They are discriminated against in private care for their low cover — as I witnessed recently — and the public hospitals are ill-equipped to be dependable.
The poor state of public hospitals, therefore, drives many into the hands of private clinics and hospitals, where patients and their families undergo further hardship both financially and psychologically.
The government needs to prioritise best healthcare for all, not just the ruling class and civil servants and generally employed Kenyans.
But it ought to consider whether it is fair and constitutional to have governors, MPs, MCAs, civil servants and the Executive on private cushy insurance while the rest of the citizenry that is self-employed, unemployed and outright poor is put on the lowest NHIF cover.
UHC will be realised by removing private insurance cover for all government workers to create equality in health provision and save money that can be utilised in public hospitals.
Secondly, the most crucial part is improving services in public hospitals by increasing capacity and remuneration for health workers to improve on quality through motivation and reduce brain drain.
Thirdly, require all state officers and public officials to attend public hospitals like the rest. It can’t be that the taxpayer gets the worst hospital care compared to those they elect and appoint to public office.
A policy that is tiered to give a small class of the population the best healthcare is unconstitutional and violates the Bill of Rights on discrimination and socioeconomic rights for all.
NHIF, therefore, is not fit for purpose in its current form. It cries out for urgent review to create a healthcare policy to serve all Kenyans equally.
Above all, the increase in private healthcare needs to be checked to minimise exploitation and discrimination of patients.
Lastly, poor funding and corruption are the biggest enablers of discrimination in the health sector. They need concerted efforts to tackle for the country to achieve UHC.
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